Healthcare Compliance Perspective:
Fraudulent behavior often involves all opportunities available to the perpetrator. This may, on the surface, appear to support a pessimistic view of limitless injury to our healthcare system; however, this also offers hope that more than one opportunity exists to catch such illegal behavior.
An Ohio woman has been sentenced in U.S. District Court to 36 months in prison for committing healthcare fraud and willful failure to pay taxes. According to court documents, the woman had owned and operated an Ohio home healthcare facility since 1993.
From 2009 until 2015, she executed a scheme to defraud the Ohio Medicaid Program by billing on behalf of the home healthcare facility for nursing services that were never rendered. The defendant routinely changed the claim information in the billing software to falsely reflect that additional hours of nursing services had been provided and falsely increased the number of nursing visits from one visit per week to between three and five visits per week.
The woman also submitted claims for nursing services of Medicaid patients who were ineligible because they were either residing in private nursing homes or deceased. Her scheme included fraudulent claims in the amount of approximately $2.2 million.
In addition to her fraudulent claims scheme, from 2009 until 2013, she maintained the books and records regarding payroll for the home healthcare business. During that time, she submitted Forms 941 to the IRS but did not pay federal employment taxes in the amount of $366,825.
The former home healthcare facility owner pleaded guilty to tax and healthcare fraud charges in June 2017. Regarding that plea agreement she has agreed to pay more than $2.2 million in restitution to the Ohio Medicaid Program and nearly $367,000 to the IRS.
